Facilitating post traumatic growth

Background: Whilst negative responses to traumatic injury have been well documented in the literature, there is a small but growing body of work that identifies posttraumatic growth as a salient feature of this experience. We contribute to this discourse by reporting on the experiences of 13 individuals who were traumatically injured, had undergone extensive rehabilitation and were discharged from formal care. All participants were injured through involvement in a motor vehicle accident, with the exception of one, who was injured through falling off the roof of a house.
Methods: In this qualitative study, we used an audio-taped in-depth interview with each participant as the means of data collection. Interviews were transcribed verbatim and analysed thematically to determine the participants' unique perspectives on the experience of recovery from traumatic injury. In reporting the findings, all participants' were given a pseudonym to assure their anonymity.
Results: Most participants indicated that their involvement in a traumatic occurrence was a springboard for growth that enabled them to develop new perspectives on life and living.
Conclusion: There are a number of contributions that health providers may make to the recovery of individuals who have been traumatically injured to assist them to develop new views of vulnerability and strength, make changes in relationships, and facilitate philosophical, physical and
spiritual growth.

Hope seen through the eyes of 10 Australian young people

Aim. The aim of this paper is to report the findings of a phenomenological study that explored hope in 10 young people in Australia.

Background. Evidence suggests many Australian young people are in crisis. Examination of key reports that detail the incidence of suicide, early drug-taking behaviours, homelessness, self-harm behaviours, joblessness, depressive disorders, crime statistics and alcohol abuse suggest that many of today's young people have lost resilience as well as vital connections to their community.

Method. Two methods were employed to encourage the participants to reflect on their experiences of hope – what it is and what it meant to them. The first was to supply participants with a disposable colour film camera and ask them to take pictures that, in their view, showed hope. The second was participation in an in-depth interview that was prompted in part, by their photographs. Interview audiotapes were transcribed verbatim and analysis of the text used the Turner method. The data were collected in 2002.

Findings. Four horizons of hope were revealed: at-one-with; a driving force; having choices; and connecting and being connected. These horizons are discussed, showing how, or if, the literature treats these dimensions of hope. Perspectives are offered on how they might be considered by nurses who are charged with caring for today's young people.

Conclusion. Registered Nurses who work with young people must understand the phenomenon of hope from their unique perspective before they can offer appropriate hope-facilitating strategies.

Hope promoting strategies of registered nurses

Aim. This paper describes self-reported hope-promoting strategies used by Registered Nurses whilst providing care for older patients in acute and long-term care settings.
Background. The literature is replete with claims that Registered Nurses engage in hope facilitation with their patients. However, these claims are largely conjecture, with few studies empirically identifying the extent to which Registered Nurses use hope interventions with their patients. Further, some authors have questioned whether nurses have the necessary skills to undertake this vital aspect of care.
Methods. In this Gadamerian hermeneutic phenomenological study, undertaken in 2003 in Australia, we used in-depth audiotaped interviews to collect data with 14 Registered Nurses. The interviews were transcribed verbatim and analysed using the Turner method.
Findings. Whilst participants clearly reported that they engaged in hope facilitation with older patients, there were differences between the reported strategies used by Registered Nurses in acute and long-term care settings. Further, the strategies reported were not unique to hope promotion and have been variously described in the literature on caring, presencing, holistic nursing and therapeutic nursing.
Conclusion. It is clear that participants considered hope promotion to be a vital aspect of their care. However, the strategies that they reported were limited and not inclusive of many and varied suggestions emerging from published studies on hope promotion. Therefore, we recommend that nursing curricula, professional development and in-service education programmes place hope facilitation on their agenda and foster a culture in which promoting hope is seen as a vital aspect of nursing care.

The clinical landscape of critical care: nurses' decision-making

Background. Many studies have tended to explore individual characteristics that impact on nurses' decision-making, despite significant acknowledgement that context is a major determinant in decision-making. The few studies that have examined environmental influences have tended not to study real decisions in the dynamic and complex clinical environment.

Aims. To investigate environmental influences on nurses' real decisions in the critical care setting.

Method. Naturalistic observations and semi-structured interviews were conducted with 18 critical care nurses in private, public and rural hospitals. Observations and interviews were recorded, transcribed verbatim and coded for themes using content analysis.

Results. All clinical decisions were strongly influenced by the context in which the decision was made. Three main environmental influences were identified: the patient situation, resource availability and interpersonal relationships. Time and risk guided all clinical decisions. Nurses established the state of the situation, the time constraints on decisions and the level of risk involved for both patient and nurse.

Conclusions. Decision-making is a manifestation of the landscape and although an increased understanding of the landscape is required, more important is the need to measure the impact of contextual variables on nurses' decision-making in order to improve health care outcomes.

Returning to work: exploring the experiences of women with acute coronary syndromes

Aims: The aim of this study was to explore the transition experiences of Australian women in resuming paid employment after an acute coronary syndrome (ACS) event. Background: Until recently cardiovascular research has focused predominantly on men but this is changing and research exploring women’s experiences of ACS has increased. Despite knowing that many women do not resume paid employment following an ACS event, little is known about the experience of those women who do, even though it is understood that returning to the previous level of employment after an ACS event is a positive outcome. Design: An exploratory qualitative approach underpinned by naturalistic inquiry was undertaken. Methods: A purposive sample of seven women who had experienced their first ACS event 12 months ago was selected. Each woman was interviewed using a semi–structured format and their interviews were transcribed verbatim. Thematic analysis of the transcript set and conceptual mapping were employed to formulate key themes. Findings: All women (mean age 52.6 years) resumed paid employment at various stages during their recovery, but reported similar transition processes. Three key themes representing this process were identified: primary motivation; influence through guidance and support; and resuming paid employment. Conclusions: Study findings revealed that these women required substantial support from family, friends and employers, with ongoing guidance from health professionals to return to paid work. The time frames for their return varied and some modified their roles within the workforce to enable them to return to paid work. However, formal cardiac rehabilitation did not appear to have a significant impact on these participants' decisions to return to work. They felt that more information about this decision may have been helpful if given at the time of cardiac rehabilitation.

Qualitative analysis of the care of children in hospital in four countries : part 1

As part of a large study of the care of children in Australian, British, Indonesian, and Thai hospitals, qualitative methods were used to examine differences influenced by culture. Two groups were surveyed: parents of hospitalized children, and staff caring for them. Vignettes were used to invoke discussion, and content analysis was used to examine the data. Subjects were interviewed singly, or in focus groups. These interviews were audiotaped and transcribed verbatim. The data were explored by using content analysis to extract themes of understanding of cultural experiences. This article is the first of a two-part series, and includes a review of the literature, description of the methods used, and results of the parents' interviews. The staff results and discussion will be published in Part 2. Analysis revealed that parents in all countries were primarily concerned with treating the child's illness and the child's recovery. Parents were concerned with their work (employment), but this was a much larger consideration in Indonesia and Thailand, where no social security systems exist, than in Australia and Britain. Communication with staff was the most commonly mentioned theme for parents, indicating that irrespective of the culture in which the care was given, good communication between parents and staff was of paramount importance.

Close, but still too far: the experience of Australian people with cancer commuting from a regional to a capital city for radiotherapy treatment

This paper reports the findings of a study undertaken in November 2001 on the experiences of 17 rural people from the regional city of Toowoomba who had been diagnosed with cancer and were required to travel to the capital city of Queensland (Brisbane) for radiotherapy. The interviews were tape recorded; the recordings were transcribed verbatim and analysed for emergent themes and subthemes, following verification by the participants that the transcription was a true record of their experience. The major themes that arose from the study were (1) the burden of travel; (2) the difficulties of living in accommodation that is not one's own home; (3) the financial burden caused by the need to relocate or travel to and from Brisbane; (4) the lack of closeness to family and friends; (5) and feelings of being a burden on others. The findings suggest that at a time of stress, an increasing burden is placed on cancer clients and their families if they are required to travel for radiotherapy. Health professionals who read the results of this study should be aware of the isolation of rural people who have to live in an unfamiliar environment at a time of great stress. Support mechanisms should be put into place in these referral centres to deal with these stressors.

The early postnatal period : exploring women's views, expectations and experiences of care using focus groups in Victoria, Australia

Background: There is growing evidence from Australia and overseas that the care provided in hospital in the early postnatal period is less than ideal for both women and care providers. Many health services face increasing pressure on hospital beds and have limited physical space available to care for mothers and their babies. We aimed to gain a more in-depth understanding of women's views, expectations and experiences of early postnatal care.

Methods: We conducted focus groups in rural and metropolitan Victoria, Australia in 2006. Fifty-two people participated in eight focus groups and four interviews. Participants included eight pregnant women, of whom seven were pregnant with their first baby; 42 women who were in the postpartum period (some up to twelve months after the birth of their baby); and two partners. All participants were fluent in English. Focus group guides were developed specifically for the study and explored participants' experiences and/or expectations of early postnatal care in hospital and at home, with an emphasis on length of hospital stay, professional and social support, continuity of care, and rest. Discussions were audio-taped and transcribed verbatim. A thematic network was constructed to describe and connect categories with emerging basic, organizing, and global themes.

Results: Global themes that emerged were: anxiety and/or fear; and the transition to motherhood and parenting. The needs of first time mothers were considered to be different to the needs of women who had already experienced motherhood. The women in this study were generally concerned about the safety of their new baby, and lacked confidence in themselves as new mothers regarding their ability to care for their baby. There was a consistent view that the physical presence and availability of professional support helped alleviate these concerns, and this was especially the case for women having a first baby.

Conclusion: Women have anxieties and fears around early parenting and their changing role, and may consider that the physical availability of professional care providers will help during this time. Care providers should be cognisant of these potential issues. It is crucial that women's concerns and needs be considered when service delivery changes are planned. If anxiety around new parenting is a predominant view then care providers need to recognise this and ensure care is individualised to address each woman's/families particular concerns.

Straight to the source : an exploratory study of Australia's regional newspaper journalists' checks on validity and accuracy of sources

This paper reports on an exploratory study that examined whether journalists
undertake the vital role of checking the validity and accuracy of information
supplied to them in media releases. It also monitored how much information
journalists used from press releases in their published work. The study followed Gandy's information subsidy theory by surveying 10 local government media relations officers who regularly issued media releases via
electronic mail or facsimile to a sample of 14 rural/regional newspapers. The data analysed found that rural/regional journalists were not adequately verifying information supplied in media releases and using a significant amount of this information verbatim.

Physical activity in the life of a woman with severe cerebal palsy : showing competence and being socially connected

We used a life-history approach to investigate the meanings and experiences of physical activity in the life of a 25-year-old woman with severe cerebral palsy (Amy). Amy and her mother were interviewed about Amy's life and her involvement in physical activity. The conversation was audio-recorded and transcribed verbatim. We interpreted Amy's story using psychodynamic theory. Although Amy enjoyed learning to walk, she developed a sense of inferiority on entering the school environment because her skills did not compare favourably with those of her classmates without disabilities. Despite these negative experiences, Amy became more physically active as an adult than she had been as a child and as an adolescent, with the intention of delaying further functional decline, to stay socially connected to the people around her and to gain self-esteem through displaying competence at physical tasks. For Amy, engaging in physical activity was intimately tied to psychosocial growth, especially as a young adult. Further research should be conducted to investigate whether this relationship between physical activity and psychosocial growth is present in the lives of other people with disabilities.

Patients and nurses' perspective on oxygen therapy : a qualitative study

Aim. This paper is a report of a study to describe patients' and nurses' perspectives on oxygen therapy.
Background. Failure to correct significant hypoxaemia may result in cardiac arrest, need for mechanical ventilation or death. Nurses frequently make clinical decisions about the selection and management of low-flow oxygen therapy devices. Better understanding of patients' and nurses' experiences of oxygen therapy could inform clinical decisions about oxygen administration using low-flow devices.
Methods. Face-to-face interviews with a convenience sample of 37 adult patients (17 cardio-thoracic: 20 medical surgical) and 25 intensive care unit nurses were conducted from February 2007 to September 2007. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach.
Findings. The patients identified three key factors that underpinned their compliance with oxygen therapy: (i) device comfort; (ii) ability to maintain activities of daily living; and (iii) therapeutic effect. The nurses identified factors, such as: (i) therapeutic effect, (ii) issues associated with compliance, (iii) strategies to optimize compliance, (iv) familiarity with device, (v) triggers for changing oxygen therapy devices, as being key to the effective management of oxygen therapy.
Conclusion. Differences between the patients' and nurses' perspective of oxygen therapy illustrate the variety of factors that impact on effective oxygen administration. Further research should seek to provide a further in-depth understanding of the current oxygen administration practices of nurses and the patient factors that enhance or hinder effectiveness of oxygen therapy. Detailed information about nurse and patient factors that influence oxygen therapy will inform a sound evidence base for nurses' oxygen administration decisions.

Do mass media campaigns capture and describe the experience of stroke symptoms?

Introduction: In 2006, the National Stroke Foundation of Australia launched the FAST (Face, Arm, Speech)/ Signs of Stroke (SOS) (5 symptom categories) campaigns designed to improve public awareness of stroke symptoms and the sense of urgency to present to hospital. However, there is little published review of how well such campaigns capture and describe the experience of stroke. This study aims to examine the awareness, content and language of the FAST/SOS campaigns by those experiencing stroke symptoms.
Methods: Interviews were conducted with either the stroke patient or a witness (incapacitated patients) whilst an inpatient at Box Hill or Maroondah Hospitals between August 2006 through April 2008. They were asked to describe awareness of campaigns, symptoms experienced (recorded verbatim and coded into campaign symptom categories) and to evaluate the descriptions of “Signs of Stroke” against their own experience (exact, somewhat, or not at all).
Results: Of 239 eligible stroke cases, 167 (70%) were interviewed (100 patients and 67 witnesses). Few (n= 20, 12%) were aware of the FAST campaign and only 16% recalled all three symptoms. Most recalled that it was “something” to do with the face, however facial droop (n=6) was less commonly experienced compared to speech impairments (n=16) and arm drift (n=13). FAST symptoms detected 84% (patients 77% and witnesses 94%) and SOS symptoms 100% of stroke patients. Patients not describing a FAST symptom (n=27) described: arm or hand numbness; hand incoordination; leg impairments; vision disturbances; or collapse. Approximately, half of patients and witnesses thought the SOS descriptions of the most commonly detected symptoms (arm/leg/face weakness or paralysis or numbness and speech impairments) exactly described the experience. Common language used to describe symptoms were: incoordination of hands or limbs; sudden difficulty walking; drooped/dropped face or mouth; slurred or loss of speech; pins and needles or tingling.
Conclusion: Both campaigns identified symptoms most commonly detected in those experiencing and reacting to symptoms. Both campaigns could portray symptoms more realistically using common descriptors without impacting on the simplicity of the messages

An examination of police officers' notes of interviews with alleged child abuse victims

This study provided a critical examination of handwritten records (notes) of interviews contained in a sample of 89 police case files about alleged child abuse. Some of the notes examined related to initial disclosure (complaint) interviews which were not electronically recorded and were meant to be recorded verbatim. Notes of electronically recorded interviews, which merely constituted a convenient summary of the case details, were also examined. Collectively, the analyses focused on the accessibility, completeness and accuracy of the notes, and the degree to which the interviewers' questions and witnesses' answers were differentiated. In relation to the disclosure interviews, a substantial proportion of these were not accessible. Of those where the notes were obtained, the detail recorded was not a complete record of conversation, and there was often poor delineation of questions and responses. Analysis of the electronically recorded interviews showed that these were not an entirely accurate summary of event details even though the note takers' sole task was to document the interview. The implications of these findings are discussed.

The communication skills used by deaf children and their hearing peers in a question-and-answer game context

Communication is frequently characterized by a sequence of questions and answers. Little is known about how well students who are deaf or hard of hearing (deaf/HH) understand their hearing classmates in the context of an inclusive setting. This study explored the communication skills used by deaf/HH children when asking and answering questions in a “trivia” game with their hearing peers. Thirty-four children with normal hearing and 34 children with a hearing loss ranging from mild to profound (>90 dB HL) participated in this study. Each of the 34 dyads included 1 child with normal hearing and 1 child with hearing loss, matched by gender and grade level at school. Dyads were videotaped and analyzed. Pairs were compared in terms of their capacity to repeat the question, strategies used to seek information, and accuracy of responses. Results showed that the group of hearing children was able to repeat more questions verbatim compared to the deaf/HH children. The deaf/HH group required a significantly greater number of repetitions, sought a greater number of general clarifications, and correctly answered more questions compared with the group of hearing children. The implications of these findings are discussed in terms of peer communication and pragmatic skill development.

Police officers' note-taking of interviews with alleged child abuse victims

The field and experimental studies for this thesis revealed that: the quality of documentation of 'disclosure' (initial) interviews with child abuse witnesses was poor; under optimal note-taking conditions, verbatim records of interview were still not provided, and considerable variability was observed in the quality of notes and strategies employed to document content and structure. The portfolio presents four case studies to illustrate similarities and/or differences between offence behaviour in child sex offenders with impairment, and the offence behaviours that characterise Canter et al.'s intimate, criminal-opportunistic and aggressive type offenders.